Fear Disorders- Panic, Phobia, PTSD

Question 1

Panic disorder

Answer 1

vere and recurrent panic attacks without obvious precipitant

• Sudden onset palpitations
• Chest pain
• Choking sensation
• Dizzy
• Feeling of unreality
• Secondary fear of dying, losing control or going mad

Question 2

PTSD

Answer 2

anxious, avoidant, disturbed sleep, trauma, nightmares, triggers, hyperarousal, anger outburst, insomina, poor concentration

mild and occuring within 4 weeks of trauma- watchful wait.
severe and persistant- trauma based CBT, EMDR

1st line: SSRI antidepresseant
or venlafaxine

Question 3

Panic disorder

Answer 3

panic attacks (somatic symptoms, cognitive deficits)
patient believes a large misfortune is about to happen to them (e.g. heart attack)
lots of sympathetic stimulatory events (sweating, tachycardia, palpitations, tremor, rapid over breathing)

Shortness of breath
Dizziness or light-headedness
Palpitations
Shaking  / tremor
Sweating
Numbness or tingling int he hands and feet (parasthesia)
Hot flushes or chills
Chest pain
Fear of dying
Fear of impulsive uncontrolled behaviour

Question 4

panic disorder/attacks management

Answer 4

psychoeducation
breathing techniques
relaxation techniques
CBT
pharmacological management- benzo's, long term antidepressants (SSRI)

Question 5

phobias

Answer 5

a type of anxiety disorder which is only provoked in certain situations. no symptoms provided they avoid the stimulus.

animals- spiders, snakes, rats, moths

situations:
air phobia
claustrophobia
social phobia
agoraphobia (unfamiliar spaces / crowded space)
acrophobia (drafts)
iatrophobia (doctors)
astraphobia (lightening)

Question 6

PTSD

Answer 6

occurs after a particularly traumatic event (war, assault, rape)

• intrusive recollections, nightmares, flashbacks
• avoidance behaviour
• hyperaurosal (exaggerated startle response, irritability, anger, insomnia, hypervigilence)

months after the incident

Question 7

management of PTSD

Answer 7

CBT, EMDR (eye movement desensitisation and reprocessing)

TCA’s, SSRI

Question 8

OCD

Answer 8

anxiety associated with obsessive thoughts and compulsive ritualistic behaviour

obsessions: unwanted, intrusive thoughts which the patient attempts to resist
compulsions: behaviour that results from the obsessive thoughts. pt believes there will be a bad outcome and the compulsions will partially and temporarily relieve the anxiety caused by the thoughts.

Question 9

OCD management

Answer 9

psychotherapy (CBT)

medication (SSRI)

Question 10

adjustment disorder

Answer 10

anxiety symptoms within 3 months of an acute life stressor
responds to psychotherapy
if > 6 months then consider an alternative diagnosis

Question 11

what is somatic symptom disorder

Answer 11

(previously known as hysteria)

<30 years old
more common in women
GI (nausea, vomiting, abdo pain)
gynae (pelvic pain, dysmenorrhea)
cardiac (palpitations, SOB, chest pain)
neurological (amnesia, voice changes, dizzy, difficulty asking)
pain

tx: counselling